Indigenous Voice to Parliament
We need to talk less and listen more.
Later this year Australians will be asked to vote on an historic referendum to give a voice to First Nations people. The path to constitutional recognition has been a long and difficult one, and there is no guarantee of a successful outcome. Our last referendum was held in 1999 to decide whether Australia should become a republic. The proposal was roundly defeated with only 45% of people voting YES, and even fewer people (39%) voting in favour of inserting a preamble to the constitution that would have recognised Aborigines and Torres Strait Islanders as the nation's first people.
Indeed, there has only been 8 out of 44 successful referendum questions in our history. Interestingly (and perhaps a sign that should give us hope), the 1967 referendum, which gave the Parliament the powers to legislate for Indigenous Australians, was overwhelmingly supported by voters. It received a resounding 90.8% YES vote, with a majority in all states. For context, the next most successful referendum was in 1906 when 82.7% of Australians voted to move the date of Senate elections. Two of the other successful referenda received less than 55% overall support. Constitutional change is not easy.
Many wonder why such a change to our Constitution is important right now, and what difference it will make. We know that the life expectancy of Aboriginal and Torres Strait Islanders is significantly less and they will suffer a higher burden of illness than other Australians. There is no doubt that this is the result of more than two hundred years of dispossession, social exclusion and economic disadvantage which all influence health outcomes. We see this play out in oral health too, with higher rates of tooth decay and tooth loss, and poorer access to dental services. And as much as we continue to try and close this gap, these health disparities continue. More of the same is not the solution.
My (limited) experience working with First Nations communities has taught me that we need to talk less and listen more if we have any chance to solve these problem. More than 25 years ago I worked for an Aboriginal dental service in rural New South Wales. They had significant challenges in recruiting and retaining dental staff, which meant that ongoing and regular access to care was difficult. Most of the patients that I saw had much higher rates of disease than the other patients that I saw outside of this clinic.
We also had a high rate of cancelled or failed appointments – much higher than I had experienced in any of the places I had worked previously or since. Many colleagues would put this down to a lack of priority placed on oral health (the old personal responsibility argument), but I suspect that it speaks more to issues around cultural safety in accessing health care. This wasn’t a a part of my training as a dentist, but fortunately that is changing now as cultural safety is becoming embedded in dental practitioner training. There were also no First Nations staff working in the clinic, and in hindsight it is easy now to recognise why many people may have had a profound distrust that kept them away despite the dental problems that they experienced.
Professional competencies of the newly qualified dental practitioner
Newly qualified dental practitioners must be able to:
acknowledge colonisation and systemic racism, social, cultural, behavioural and economic factors which impact individualand community health
foster a safe working environment through leadership to support the rights and dignity of Aboriginal and Torres Strait Islander people and colleagues
provide culturally safe care to diverse groups and populations, recognising barriers to accessing care and responding to the distinct needs of those at increased risk of poor oral health
Much later I was involved in a research study looking at the oral health of Aboriginal and Torres Strait Islander children in the Northern Peninsula Area of the Cape York Peninsula in Queensland. I was there as part of the Army Community Assistance Program that would regularly visit remote communities and build local infrastructure and provide healthcare. The Queensland government was looking to introduce water fluoridation to address what they perceived to be higher rates of dental disease in this particular community. It wasn’t lost on me that most of the rest of Queensland remained unfluoridated at that time that they were proposing to fluoridate one of the remotest communities in the state. It was yet another example of a a well-meaning but externally imposed ‘solution’ to a problem that ironically was very much a product of colonisation (given that tooth decay was almost non-existent prior to European settlement).
Nonetheless, we undertook a baseline study of tooth decay experience, performing dental examinations for 486 of the 594 school children aged 4-15 years. The results were confronting: 80% of children aged 4-9 years had tooth decay in their deciduous (baby) teeth and 73% of children aged 9-15 years had tooth decay in their permanent (adult) teeth. Twelve-year-old children had more than 4 times the number of teeth affected by tooth decay than the Australian average and nearly 3 times the Queensland average. One third of these children had 7 permanent (adult) teeth affected by tooth decay at the age of 12 years. It was easy to see the reason why - kids would turn up to school with a can of sugary soft drink and a lollipop. The personal responsibility crowd would have had a field day. No amount of fluoride in the water was going to overcome the oral health challenges that these kids were facing, but neither was placing the blame on the oral health and dietary habits of the children.
Which brings be back to the Voice, and the need for us to talk less and listen more. We are on a journey of reconciliation in this country. The 1967 referendum was a critical step. The National Apology was another landmark event, with the Government acknowledging the impact that colonisation has had on First Nations people.
We apologise for the laws and policies of successive Parliaments and governments that have inflicted profound grief, suffering and loss on these our fellow Australians. We apologise especially for the removal of Aboriginal and Torres Strait Islander children from their families, their communities and their country.
Prime Minister Kevin Rudd, 13 February 2008
The Voice is the next important step on this journey, and one that is important that we get right. We must recognise First Nations people within our Constitution. Those of us who enjoy the privilege of good health and don’t experience the challenges of racism, social exclusion or relative disadvantage may find it difficult to understand how these things can impact people’s health and well being. But the evidence for this is overwhelming. Constitutional recognition and a Voice will help to rebalance these injustices. We have an opportunity to make change now, and we must not waste it.
We need to talk less and listen more. I will be voting YES.